What Are Common Causes of a Cough and Shortness of Breath?

Cough is a defensive reflex movement that can prevent the inhalation of foreign bodies, prevent the accumulation of bronchial secretions, and clear the secretions to avoid secondary respiratory infections. Any cause of acute or chronic inflammation of the respiratory tract can cause cough. According to the course of disease can be divided into acute cough, subacute cough and chronic cough.

Basic Information

English name

infantile cough

Visiting department

Pediatrics

Multiple groups

Children

Common causes

Respiratory infection and cough after infection, cough variant asthma, upper airway cough syndrome, gastroesophageal reflux cough, eosinophilic bronchitis, congenital respiratory disease, psychogenic cough, foreign body inhalation, drug-induced Cough, otogenic cough, etc.

Common symptoms

Cough is accompanied by other symptoms or signs that can indicate a specific cause, that is, cough is one of the symptoms of these diagnosed diseases. Or cough was the main or only manifestation, and chest X-ray showed no abnormal chronic cough.

Pediatric cough classification

According to the course of disease can be divided into acute cough, subacute cough and chronic cough.

Acute cough

It means the course of disease is less than 2 weeks, and it is more common due to upper or lower respiratory infections and acute asthma attacks.

2. Subacute cough

It means that the course of disease is more than 2 weeks and less than 4 weeks. In addition to respiratory infections, bacterial sinusitis and asthma can be seen.

3. chronic cough

A cough that persists for more than 4 weeks is called chronic cough. (The following content of this entry is mainly about chronic cough)

Causes of cough in children

The age of children should be fully considered in the clinical diagnosis of children with chronic cough, and the etiology is different at different ages.

Common cause

(1) Respiratory tract infection and cough after infection

1) Respiratory infections Respiratory infections caused by many pathogenic microorganisms such as pertussis, tubercle bacilli, viruses (especially respiratory syncytial virus, parainfluenza virus, cytomegalovirus), mycoplasma pneumoniae, chlamydia, etc. are common causes of chronic cough in children , More common in preschool children <5 years old.

2) Cough after infection. Acute respiratory infections. Cough symptoms that last more than 4 weeks can be considered after infection. The mechanism may be that the integrity of the airway epithelium is damaged by infection and / or the squamous metaplasia of ciliated columnar epithelial cells and / or persistent airway inflammation accompanied by temporary airway hyperresponsiveness. The clinical features and diagnostic clues of cough after infection are: recent clear history of respiratory infections; cough showing irritating dry cough or a small amount of white sticky sputum; chest X-ray examination is normal; lung ventilation is normal; cough Usually self-limiting; Except for other causes of chronic cough. If the cough is longer than 8 weeks, other diagnoses should be considered.

(2) Cough variant asthma (CVA)

CVA is one of the common causes of chronic cough in children, especially preschool and school-age children. The clinical features and diagnostic clues of CVA are: continuous cough> 4 weeks, often onset at night and / or early morning, exacerbation of cough after exercise, cold air, no clinical signs of infection, or ineffective antibiotic treatment after a long time; Diagnostic treatment of bronchodilators can significantly relieve cough symptoms; lung ventilation is normal, bronchial provocation test indicates airway hyperresponsiveness; history of allergic diseases including drug allergies and family history of positive allergic diseases. A positive allergen test can assist diagnosis; Excluding chronic cough caused by other diseases.

(3) Upper Airway Cough Syndrome (UACS)

A variety of rhinitis (allergic and non-allergic), sinusitis, chronic pharyngitis, chronic tonsillitis, nasal polyps, adenoidal hypertrophy and other upper airway diseases can cause chronic cough. Previously diagnosed as postnasal drip (flow) syndrome (PNDs), which means cough caused by nasal secretions flowing back through the nostril to the pharynx. The clinical features and diagnostic clues are as follows: chronic cough with or without sputum, coughing in the early morning or when the body changes, often accompanied by nasal congestion, runny nose, dry throat and foreign body sensation, repeated clearing of the pharynx, and posterior pharynx Mucus adhesion, a few children complained of headache, dizziness, low fever, etc. Check the sinus area for tenderness, yellow-white secretion at the opening of the sinus, and the follicles in the posterior pharynx wall are obviously hyperplasia, cobblestone-like, sometimes visible Mucosa-like attachment to the posterior pharyngeal wall; targeted treatments such as antihistamines and leukotriene receptor antagonists, nasal glucocorticoids are effective; caused by sinusitis, plain X-ray film or CT film Change accordingly.

(4) Gastroesophageal reflux cough (GERC)

Gastroesophageal reflux (GER) is a physiological phenomenon in infancy. The incidence of GER in healthy infants ranges from 40% to 65%, peaks in 1 to 4 months, and it usually resolves naturally at 1 year of age. When it causes symptoms and / or gastroesophageal dysfunction, it becomes a disease called gastroesophageal reflux disease (GERD). The clinical features and diagnostic clues of GERC are: paroxysmal cough, sometimes severe cough, mostly at night; most of the symptoms appear after diet, feeding difficulties. Some children are accompanied by discomfort in the upper abdomen or under the xiphoid process, burning sternum, chest pain, and sore throat. In addition to cough, infants can cause suffocation, bradycardia, and bowed back; can cause growth and development in children Stagnation or delay.

(5) Eosinophilic bronchitis (EB)

The clinical features and diagnostic clues of EB are: chronic irritating cough; chest X-rays are normal; lung ventilation is normal without airway hyperresponsiveness; relative percentage of eosinophils in sputum is greater than 3%; Oral or inhaled glucocorticoids are effective.

(6) Congenital respiratory diseases

It is mainly found in infants and young children, especially under 1 year old. Including congenital tracheoesophageal fistula, congenital vascular malformation to compress the airway, laryngeal and tracheobronchial softening and / or stenosis, bronchopulmonary cysts, ciliary dyskinesia, mediastinal tumors, etc.

(7) Psychogenic cough

The clinical characteristics and diagnostic clues of psychogenic cough are: more common in older children; dominated by daytime cough, focus on a certain thing or disappear at night; often accompanied by symptoms of anxiety; not accompanied by devices Qualitative diseases and other causes of chronic cough.

(8) Other causes

1) Foreign body inhalation cough is the most common symptom after foreign body inhalation in the airway. Foreign body inhalation is an important cause of chronic cough in children, especially children aged 1 to 3 years. Cough usually manifests as paroxysmal severe cough, or it can only manifest as chronic cough with obstructive emphysema or atelectasis. Once a foreign body enters the area below the small bronchus, there can be no cough. .

2) Angiotensin-converting enzyme inhibitors (ACEI) are less commonly used in children with drug-induced cough , and some children with renal hypertension may induce cough after using ACEI such as captopril. The mechanism may be related to the secretion of bradykinin, prostaglandin, substance P and so on. The cough caused by ACEI usually manifests as chronic persistent dry cough, which is aggravated at night or in the supine position. Withdrawal for 3 to 7 days can significantly reduce or even eliminate the cough. Adrenergic receptor blockers, such as propranolol, can cause bronchial hyperresponsiveness, and may also cause drug-induced cough.

3) 2% to 4% of people with otogenic cough have vagus nerve ear branches. In this part of the population, when a disease occurs in the middle ear, stimulation of the vagus nerve can cause chronic cough. Otogenic cough is a rare cause of chronic cough in children.

Clinical manifestations of cough in children

Specific cough

Refers to cough accompanied by other symptoms or signs that can indicate a specific cause, that is, cough is one of the symptoms of these diagnosed diseases. For example, cough accompanied by expiratory dyspnea, auscultation with prolonged expiration or wheezing, often suggest intrathoracic airway pathologies such as tracheobronchiolitis, asthma, and congenital airway abnormalities (such as tube and bronchial softening); Pulmonary shortness of breath, hypoxia, or cyanosis suggest lung inflammation; those with growth and development disorders, clubbing fingers (toes) often suggest severe chronic lung disease and congenital heart disease; those with purulent sputum suggest lung inflammation, bronchi Dilation, etc .; those with hemoptysis suggest severe pulmonary infection, pulmonary vascular disease, pulmonary hemosiderin, or bronchiectasis.

2. Non-specific cough

Refers to cough as the main or only manifestation, no abnormal chronic cough on chest X-ray. The current clinical chronic cough mainly refers to this type of cough, also known as "narrow chronic cough". The cause of non-specific cough in children is of age. Careful systematic evaluation, detailed medical history inquiry, and physical examination are needed for this kind of children. Chest X-ray examination is needed for this type of child. Pulmonary ventilation function examination should be performed for the appropriate age.

Pediatric Cough Diagnosis

1. Medical history and physical examination

Inquire about the medical history in detail, and try to find out the causes of chronic cough, including physical, chemical, biological reasons, etc. This has an important role in the diagnosis of the cause. Pay attention to the nature of the cough, such as canine barking, wild goose-like, intermittent or paroxysmal, etc. Pay attention to the exacerbating factors of cough and its accompanying symptoms. Those with chronic cough and sputum should pay attention to the presence of bronchiectasis and underlying diseases such as cystic fibrosis and immunodeficiency. Physical examination of the lungs and heart, with or without cyanosis on the nail bed and clubbing fingers. Pay attention to assess the child's growth and development, breathing rate, and whether the chest is deformed.

2. Auxiliary inspection

(1) Radiological examination of children with chronic cough should be routine chest X-ray examination, based on whether the chest X-ray is normal or not, determine the next diagnostic treatment or examination. Take a Kava film when sinusitis is suspected or recommend further diagnosis and treatment at the ENT. Chest CT is useful for finding small and medium lesions in the mediastinum, hilar lymph nodes, and lung fields. High-resolution CT is useful for diagnosing atypical bronchiectasis and interstitial lung disease. CT sinus films show that the thickness of the nasal conjunctiva is greater than 4mm or the level of air or fluid in the sinus cavity is opaque or opaque, which are characteristic changes of sinusitis. CT and MRI examinations of the sinuses are one of the indispensable diagnostic methods, but they should not be classified as routine examinations, depending on the condition of the doctor. The interpretation of the results also needs to be cautious in children, especially children under 1 year old, because the paranasal sinuses are not fully developed and the upper and lower ethmoid sinuses are present but small at birth. The frontal and sphenoid sinuses only appear at the age of 5 to 6 years, and the structure is unclear. Imaging alone can easily lead to excessive diagnosis of "sinusitis".

(2) Pulmonary function: Children over 5 years of age should be routinely tested for pulmonary ventilation. If necessary, a one-second forced expiratory volume (FEV1) can be used to conduct a bronchodilator test or bronchial provocation test to assist the diagnosis of asthma (including CVA). And identification with EB.

(3) Bronchoscopy (fiber bronchoscopy, rigid bronchoscopy, etc.) is feasible for suspecting chronic cough caused by malformations of airways, foreign bodies (including foreign bodies in the airways, sputum plugs), etc., and inspection of pathogenic microorganisms that require anti-pollution Bronchoscopy.

(4) Cytological examination of induced sputum or bronchoalveolar lavage fluid and the isolation and culture of pathogenic microorganisms can identify or indicate the pathogen of respiratory infection. If eosinophils increase, it is the main indicator for diagnosis of allergic inflammation such as EB.

(5) Other PPD skin tests, serum total IgE and specific IgE measurements, skin prick tests, 24-hour esophageal pH monitoring, and esophageal lumen impedance testing. The diagnostic value of exhaled nitric oxide measurement, tracheobronchial biopsy, and cough sensor sensitivity tests in children with chronic cough are uncertain.

Pediatric Cough Treatment

The principle of managing chronic cough in children is to identify the cause and treat the cause. If the cause is unknown, empirical symptomatic treatment can be used to achieve effective control; if the cough symptoms do not ease after treatment, they should be re-evaluated. Antitussives should not be used in infants.

Drug treatment

(1) Expectorant Drugs If chronic cough is accompanied by sputum, the principle of expectorant should be used instead of simply coughing, so as not to aggravate or cause airway obstruction. N-ethylphenol cysteine, amoxol hydrochloride, guaiac Lignin glyceryl ether and Chinese medicine expectorant.

(2) Antihistamine drugs such as chlorpheniramine, loratadine, cetiridam, etc.

(3) Antibiotics are considered to be chronic infections of bacteria or Mycoplasma pneumoniae and Chlamydia pathogens. People infected with Mycoplasma pneumoniae or Chlamydia can choose macrolide antibiotics, including erythromycin, azithromycin, and clarithromycin. After the initial experience of other pathogenic infections, if antibiotics need to be adjusted, they should be selected according to the results of drug sensitivity tests.

(4) Asthma anti-inflammatory drugs include glucocorticoids, 2 receptor agonists, M receptor blockers, leukotriene receptor antagonists, theophylline and other drugs. Mainly used for targeted treatment of CVA, EB, allergic rhinitis and so on. Re-evaluation is required after 2 to 4 weeks of glucocorticoid treatment. Cough usually resolves itself after infection. For severe symptoms, short-term use of inhaled or oral glucocorticoids, leukotriene receptor antagonists, or M receptor blockers may be considered.

(5) Digestive system drugs advocate the use of H receptor antagonists such as cimetidine and gastrokinetic drugs such as domperidone.

(6) Antitussive drugs. Cough medicine is not recommended for chronic cough, especially if the cause is not clear, and the use of such drugs is related to the morbidity and mortality of some diseases. The American Academy of Pediatrics warns that codeine should be disabled in the treatment of various diseases. Types of cough. Phinegan's sedative effect may mislead parents, use the drug to reduce the noise of their children and ignore the adverse reactions of the drug, including irritability, hallucinations, abnormal muscle tone, and even apnea and sudden infant death. Adverse reactions were apparent in infants, leading WHO to warn that phenagen was banned in children under 2 years of age and banned as an antitussive.

2. Non-drug treatment

Take care to remove or avoid the factors that induce and aggravate cough. Avoid contact with allergens, cold and smoke environment; for nasal sinusitis, nasal lavage and decongestion drugs can be used; changes in body position, changes in food characteristics, small meals, etc. are effective for GERC; for foreign bodies in the airway, timely remove foreign bodies ; The best treatment for drug-induced cough is to discontinue medicine; psychotherapy can be given to psychogenic cough; timely vaccination to prevent respiratory infections and respiratory infections.

references:

[1] Respiratory Group, Pediatrics Branch, Chinese Medical Association, Guidelines for the Diagnosis and Treatment of Chronic Cough in Children, Chinese Journal of Pediatrics, 2008, Vol. 46, No. 2, 104-107.

[2] Geng Lingyun, Chen Huizhong, Zhu Chunmei, et al. Procedural diagnosis of chronic cough in children, Journal of Clinical Pediatrics, 2007, 25: 8-12.

[3] Asthma Group, Respiratory Branch, Chinese Medical Association. Guidelines for the diagnosis and treatment of cough (draft). Chinese Journal of Tuberculosis and Respiratory Medicine, 2005, 28: 738-4.